title: Estimating the long-term effects of in vitro fertilization in Greece: an analysis based on a lifetime-investment model.
abstract: OBJECTIVE
  To quantify the economic effects of a child conceived by in vitro fertilization (IVF) in terms of net tax revenue from the state's perspective in Greece.
  
  
  METHODS
  Based on previous international experience, a mathematical model was developed to assess the lifetime productivity of a single individual and his/her lifetime transactions with governmental agencies. The model distinguished among three periods in the economic life cycle of an individual: (1) early life, when the government primarily contributes resources through child tax credits, health care, and educational expenses; (2) employment, when individuals begin returning resources through taxes; and (3) retirement, when the government expends additional resources on pensions and health care. The cost of a live birth with IVF was based on the modification of a previously published model developed by the authors. All outcomes were discounted at a 3% discount rate. The data inputs - namely, the economic or demographic variables - were derived from the National Statistical Secretariat of Greece and other relevant sources. To deal with uncertainty, bias-corrected uncertainty intervals (UIs) were calculated based on 5000 Monte Carlo simulations. In addition, to examine the robustness of our results, other one-way sensitivity analyses were also employed.
  
  
  RESULTS
  The cost of IVF per birth was estimated at €17,015 (95% UI: €13,932-€20,200). The average projected income generated by an individual throughout his/her productive life was €258,070 (95% UI: €185,376-€339,831). In addition, his/her life tax contribution was estimated at €133,947 (95% UI: €100,126-€177,375), while the discounted governmental expenses for elderly and underage individuals were €67,624 (95% UI: €55,211-€83,930). Hence, the net present value of IVF was €60,435 (95% UI: €33,651-€94,330), representing a 182% net return on investment. Results remained constant under various assumptions for the main model parameters.
  
  
  CONCLUSIONS
  State-funded IVF may represent good value for money in the Greek setting, since it has positive tax benefits for the government, notwithstanding its beneficial psychological effect on infertile couples.
authors.affiliation: National School of Public Health, Department of Health Services Management, Athens, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Fragoulakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Maniadakis
keywords: benefit analysis; cost; infertility; lifetime productivity; net tax revenue